The undertreatment of LDL-cholesterol: addressing the challenge

Patients with dyslipidemia are at increased risk of coronary heart disease (CHD), while treatment to reduce low density lipoprotein cholesterol (LDL-C) concentrations lessens this risk. Consequently, the Lipid Treatment Assessment Project (L-TAP) was undertaken in the US to determine the extent to which primary care practitioners utilize lipid-lowering therapy and to evaluate the success of current therapeutic regimens, using the National Cholesterol Education Program (NCEP) guidelines as therapeutic targets. The L-TAP study, initiated in 1996 and completed in February 1997, recorded LDL-C levels in 4888 patients from 619 US practices. All patients had received lipid-lowering therapy for at least 3 months. The primary care practitioners involved in the study were questioned about the NCEP guidelines and the results confirmed that these physicians were representative of primary care practitioners in the USA. The 4888 patients were categorized according to risk: patients with <2 risk factors (RFs) but no CHD, those with ≥2 RFs but no CHD and patients with confirmed CHD. Overall, only 38% of the patients attained LDL-C target levels or had values lower than these goals. The greater the number of RFs, the lower the proportion of patients achieving target levels. LDL-C targets were less often attained in patients receiving dietary therapy only compared with those receiving lipid lowering drug treatment. However, there was good correlation between the success of treatment and both receipt of and compliance with dietary instruction. In conclusion, a large proportion of dyslipidemic patients who are being treated in primary care are not achieving NCEP target LDL-C levels.